Five priority codes, instead of the current 4, which will take into account not only the criticality level of those arriving in the emergency room, but also the clinical-organizational complexity and the care commitment necessary to activate the path, in order to optimize the “Flow” of patients and improve the care experience.
This is the main novelty introduced by the guidelines for triage in the emergency rooms of Emilia-Romagna, approved in recent days by the regional council. To the colors red, orange, green and white, blue is now added (between orange and green) which indicates a deferrable urgency, with 60 minutes as the maximum waiting time for taking charge.
The adoption of this new triage system, in line with the national guidelines, is inspired by a model of global approach to the person and his family, which will allow an even more appropriate use of human and instrumental resources, based on the complexity of the cases and the full implementation of some organizational solutions or specific paths. The goal is to identify the priority of access to care and direct the patient towards increasingly appropriate diagnostic-therapeutic paths.
The Guidelines will be applied starting from 1 October next, after a period of ad hoc training for health personnel and IT adaptation interventions that will involve the health and hospital authorities of the region.
“A further step forward to improve the reception and care of patients who access the emergency rooms in our region, which as we all know represent the main point of reference for the urgent health needs of citizens – underlines the Councilor for Policies for health, Raffaele Donini-. The new Guidelines, with the innovations that they introduce starting from the new color code and the reception and information services in the case of structures with a high number of cases, go in the direction of accelerating patient care and guaranteeing more appropriate diagnosis and treatment, also with particular attention to staff training “.
The 5 color codes of the new Guidelines
The color codes are assigned during the triage, which ensures that access to care occurs according to criteria of priority (color or numeric codes) and equity. The triage evaluation is also a fundamental moment for the acceptance and recognition of situations of fragility, which require the activation of pathways capable of providing support and facilitating care in the health, welfare and social fields. This is the case, for example, of maltreatment and abuse of minors and women, and cases of mental disorders.
The new Guidelines therefore envisage five color codes: red (for an emergency, it requires immediate evaluation by the health professionals); orange (urgency cannot be delayed, 15 minutes as the maximum waiting time for taking charge); blue (deferrable urgency, 60 minutes maximum waiting time); green (minor urgency, 120 minutes); white (non-urgent, 240 minutes). The triage method with 5 different priority levels represents the international “gold standard” and is preparatory to the creation of paths that take into consideration the clinical complexity, the care intensity and the resources used, also allowing the identification of 3 different flows post triage (high, medium and low complexity).
Triage is a “function” of nursing competence; in defining the priority, the main health problem, the level of criticality, the risk of deteriorating clinical evolution and the most appropriate treatment path are taken into account. Additional factors will contribute to the definition of the color code, such as the level of pain, age, degree of frailty and / or disability, organizational and local context peculiarities. It is a dynamic process, which implies periodic re-evaluations, since the clinical conditions of patients waiting to be taken care of by doctors can improve or worsen, so that a review of the level of priority and / or the path of care is required.
New in structural and organizational standards
The triage function must always be active during the emergency room operating hours. Each structure needs a triage station functional to the activity of the structure itself. For this reason, in the emergency rooms with a high number of cases, the creation of reception / information services is foreseen (for example, in collaboration with voluntary associations) to support the management of the waiting room. This service will have an orientation function and the dedicated people will have to be specially trained. Their task will be to ensure maximum timeliness in contact between patients and healthcare personnel.
With regard to human resources, as required by the previous resolution of the regional council, it is envisaged that in the emergency rooms with a turnout of more than 20,000 visits per year, triage is carried out by nurses dedicated to this function exclusively. In structures with a lower number of accesses, on the other hand, the triage is provided, in a non-exclusive way, by an emergency room nurse. Furthermore, based on the Guidelines, it is established that the number of dedicated nurses is increased based on the number of accesses and also modulated in relation to the different time bands / days of the week, providing, when necessary, a dedicated unit for re-evaluation.
Nurses who carry out triage activities must have completed a training course specifically created to acquire the knowledge and skills necessary to implement the new organizational methods of triage.
The Covid-19 epidemic and the definition of distinct and safe routes to the emergency rooms
The Covid-19 emergency has changed the usual operational flow of First Aid: the emergency-urgency structures of Emilia-Romagna have had to respond with particular commitment to the need to take care of citizens affected by the disease in a moderate or severe form . To do all this and, at the same time, guarantee the safety of operators and users with other assistance needs, the Region has defined with specific acts, from the beginning of the epidemic, distinct and safe paths within the Pronto rescue. In this scenario, the triage staff, assisted by the pre-triage staff, played and plays a fundamental role in recognizing the signs and symptoms of the disease and in governing, within the structure, the flows and paths dedicated to taking charge. of subjects with suspicion of Covid-19 and those for citizens with other welfare needs.
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